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Abstract

A robust body of neurophysiologic research is reviewed on functional brain abnormalities associated with depression, anxiety, and obsessive-compulsive disorder. A review of more recent research finds that pharmacologic treatment may not be as effective as previously believed. A more recent neuroscience technology, electroencephalographic (EEG) biofeedback (neurofeedback), seems to hold promise as a methodology for retraining abnormal brain wave patterns. It has been associated with minimal side effects and is less invasive than other methods for addressing biologic brain disorders. Literature is reviewed on the use of neurofeedback with anxiety disorders, including posttraumatic stress disorder and obsessive-compulsive disorder, and with depression. Case examples are provided.
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Neurofeedback with Anxiety and Affective Disorders
Journal of Child & Adolescent Psychiatry Clinics of North
America, Jan. ‘05
(This article has been lightly edited by David Dubin, MD to make it more accessible to a
general public.)
D. Corydon Hammond, PhD, ABEN/ECNS
Physical Medicine and Rehabilitation, University of Utah School of Medicine,
Compelling evidence exists for a neurophysiologic basis for obsessive-
compulsive disorder (OCD). There is also strong research evidence also
indicates that there are functional brain abnormalities associated with anxiety and
panic disorder [28–30] and post- traumatic stress disorder (PTSD) [31].
There is a strong reliance in psychiatry on the use of medication for the treatment
of depression and anxiety, although some evidence currently suggests that
medication may not be as effective in treating these conditions as has often been
believed [44–48].
Similarly, Greist [49] estimated the degree of symptomatic improvement in OCD
from treatment with serotonin drugs to only be 30%. Goodman et al [44] similarly
found that symptom amelioration in OCD treatment with serotonin uptake
inhibitors is approximately 35% on average and that only 50% of patients
experience this partial improvement.
In light of this brief review and the fact that an increasing number of patients and
parents seem interested in non- medication treatment alternatives that still
address the underlying biologic factors associated with depression, anxiety, and
obsessive compulsive disorder (OCD), it would be desirable to find a treatment
that also would help address the biologic aspects of mental health disorders.
Neurofeedback holds promise for offering such an alternative.
What is neurofeedback?
Neurofeedback is EEG biofeedback or brain wave training. Nothing intrusive is
introduced into the brain. The sensors simply measure the ongoing brain wave
activity.
Ordinarily we are unable to reliably influence our brain wave activity because we
lack awareness of it. When we are able to see representations of our brain wave
activity on a computer screen a few thousandths of a second after it occurs,
however, it allows us to modify our brain wave patterns through operant
2
conditioning.
The patient is placed in front of a computer screen. The computer display may
be as complex as a computer/video game type of display. It also may be as
simple as two bar graphs, one representing slow and inefficient brain wave
activity and the other representing efficient, beta brain wave activity. The patient
concentrates on the screen. When the inappropriate activity decreases slightly
and the appropriate activity increases slightly, a pleasant tone might be heard.
At first, changes in brain wave activity are transient. As sessions are repeated,
enduring changes are gradually seen.
EEG biofeedback (neurofeedback) has been found to be effective in modifying
brain function and producing significant improvements in clinical symptoms in
children, adolescents, and adults who have several different biologic brain
disorders.
These conditions include epilepsy, attention deficit disorder and attention deficit
hyperactivity disorder (ADHD), and learning disabilities and have included up to
10-year follow-ups of patients [57].
Neurofeedback for anxiety
A review of the literature on the neurofeedback treatment of anxiety disorders by
Moore [58] identify eight studies of generalized anxiety disorder.
The best studies of neurofeedback with anxiety were three outcome studies [59]
with phobic (test) anxiety. In each study, the group that received alpha EEG
enhancement training demonstrated significant reductions in test anxiety. In
comparison, the untreated control group and the relaxation training group
experienced no significant reduction.
In another study, with alpha training the anxiety scores dropped significantly
compared with a non-treatment group. Moore [58] concluded in his review that a
placebo effect was present in these neurofeedback studies but that alpha and
theta enhancement training provided additional effects beyond placebo and are
effective treatments for anxiety disorders.
Passini et al [70] used 10 hours of alpha neurofeedback training, comparing 25
anxious patients (23 of whom were alcoholics) with a control group of 25 anxious
patients (22 of whom were also alcoholics), most of whom were seeking
treatment at a Veterans Administration hospital brief treatment unit. The alpha
neurofeedback training produced significant changes in state and trait anxiety
compared with controls.
An 18-month follow-up of those patients was published, with virtually identical
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results of lower anxiety still found, which validated that the anxiety changes from
alpha neurofeedback were enduring [71].
Two neurofeedback outcome studies have focused on chronic PTSD. In a
randomized, controlled group study [73], 30 30-minute sessions of alpha-theta
EEG biofeedback training were added to the traditional Veterans Administration
hospital treatment that was provided to a group of 15 Vietnam combat veterans
with PTSD. The study compared them after treatment and at follow-up with a
contrast group of 14 veterans who only received traditional treatment.
In addition to the posttreatment testing, on a monthly basis, patients and
informers were contacted for a full 30-month follow-up period to determine if
there had been PTSD symptoms (eg, flashbacks, nightmares, anxiety attacks,
depression).
At follow-up, all 14 traditional treatment patients had experienced relapse,
whereas only 3 of 15 neurofeedback training patients had experienced relapse.
All 14 patients who were treated with neurofeedback had decreased their
medication requirements at follow-up, whereas in contrast, only 1 traditional
treatment patient had decreased medication needs, 2 reported no change, and
10 required more medications.
Neurofeedback training patients improved significantly on all ten MMPI clinical
scales—in many in- stances dramatically—but there were no significant
improvements on any scales in the traditional treatment group.
In another Veterans Administration hospital uncontrolled study [74], 20 Vietnam
veterans with chronic PTSD, all with alcohol abuse, were randomly selected. All
patients showed frequent (eg, two to three times per week) episodes of PTSD
and had been hospitalized for PTSD an average of five times.
They were treated with 30 30-minute sessions of alpha- theta neurofeedback
training. Follow-up interviews occurred with the patients and their wives or family
members on a monthly basis for 26 months. In that time, only 4 of the 20 patients
reported a few (one to three) instances of recurrence of nightmares or
flashbacks, and the other 16 patients had no recurrence of PTSD symptoms.
Neurofeedback for depression
Although reports to date on the application of neurofeedback to depression
only represent uncontrolled case reports, they provide encouragement that
neurofeedback may hold potential for treating mildly to severely depressed
patients and that unlike medication, it may enduringly modify the functional brain
abnormality associated with biologic predisposition to depression.
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Clinical experience and further case examples
Based on clinical experience with more than 25 patients with dysthymia, in
which most of them have been followed for between 6 and 24 months,
neurofeedback has seemed to be successful in producing significant and
enduring change in approximately 80% of the patients. There have been no
published research or clinical reports on the use of neurofeedback in a pediatric
depression sample. Because the biologic marker of a frontal alpha asymmetry
has been found in multiple studies with children and infants [38–41] of depressed
mothers, and because there is abundant evidence that children respond to
neurofeedback training for other conditions, it is reasonable to expect that this
approach would be beneficial with depressed children.
There are widespread clinical reports of improvements in mood among children
treated with neurofeedback for ADHD, which further supports the expectation
that neurofeedback may be effective with childhood depression. There also are
reports of improvements in bipolar disorder.
Neurofeedback seems to involve minimal risk of side effects or adverse reactions
[84], and it is less invasive than antidepressant medication or transcranial
magnetic stimulation.
Anxiety and insomnia
In most cases, anxiety and insomnia are readily treated with neurofeedback
[58,59,85–88]. One of the first improvements that parents often notice is that the
child falls asleep more easily and remains asleep. With anxiety patients,
neurofeedback training often is done eyes closed while listening to auditory
feedback, and in a sense it resembles high-technologic meditation training.
As a case example, a patient was referred by a physician who was a headache
specialist, indicating that everything that could be done with medication seemed
to have been done. The patient had a lengthy history of several migraines
weekly, which had progressed to daily migraines. She had been given a self-
hypnosis tape to use for anxiety management, but she complained that her mind
was so busy that she was unable to obtain much relaxation from the tape. After
20 30-minute sessions of inhibiting fast beta and reinforcing alpha activity in the
parietal area, she was off all her prescription medications. She sensed a
migraine trying to begin approximately twice weekly but would take over-the-
counter medication and could use the self-hypnosis tape successfully to abort the
headache. She felt more relaxed in general and reported no longer feeling
compelled to do two things at once.
5
Summary
As reviewed in other articles, the neuroscience technology known as EEG
biofeedback (or neurofeedback) has considerable research support in areas such
as uncontrolled epilepsy and attention deficit disorder and ADHD. In evaluating
the studies in the overall broad area of the neurofeedback treatment of anxiety
disorders, EEG biofeedback qualifies for the evidence-based designation of
being an efficacious treatment [62]. When separate anxiety disorders are
individually evaluated, the areas of phobic anxiety, generalized anxiety, and
PTSD each qualify for designation as being a probably efficacious treatment.
Currently there are only reports of cases and series of cases on the treatment of
depression and OCD and no published reports thus far on treatment of bipolar
disorder. Despite the lengthy follow-ups and use of objective measures,
neurofeedback treatment for depression and OCD is not yet empirically
supported. EEG biofeedback is an exciting, cutting-edge technology that offers
an additional treatment alternative for modifying dysfunctional, biologic brain
patterns that are associated with various psychiatric conditions.
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... Sensorimotor rhythm (SMR) training, oscillating between 12 and 15 Hz, enhances cognitive functions like selective attention and working memory, essential for optimal chess performance. Research shows that SMR training improves focus [12], reduces anxiety, and aids in managing competitive stress [13]. SMR regulation, often performed at C4 or Cz, involves reinforcing SMR while inhibiting theta and fast beta waves to promote relaxation and attention [14]. ...
... While SampEn decreased, DF1 increased in all the conditions. Figure 1 shows the SMR power spectrum (12)(13)(14)(15) after and before the BFB and NFB intervention during the six conditions. SMR power spectrum values changed after the BFB and NFB intervention. ...
... Regarding HRV improvements, a reduction in mean heart rate and an increase in RR interval were observed, indicating greater parasympathetic activation and reduced physiological stress [61]. Additionally, there was an increase in SDNN and RMSSD, suggesting enhanced autonomic adaptability and better stress management [13]. The decrease in the LF/HF ratio also indicated better autonomic regulation, crucial for maintaining calm and focus during matches [69]. ...
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Full-text available
(1) Background: Previous studies showed that neurofeedback and biofeedback could improve stress levels, enhance self-control over physiological factors, improve behavioral efficiency, and increase reaction speed to stimuli. Specifically, the sensorimotor rhythm stimulation (12–15 Hz) can enhance cognitive functions such as selective attention and working memory. However, there is no study that analyzes the effect of these interventions in chess players. (2) Methods: A Chess Woman Grandmaster and Chess International Master, with an ELO ranking higher than 2350 points, was selected to participate in this case study. The participant conducted a total of 14 sessions of biofeedback and neurofeedback, training in breathing, sensorimotor rhythm stimulation in Cz, skin conductance, temperature, and heart rate variability combined with chess work. Specific and non-specific tasks were designed to evaluate the intervention. (3) Results: The chess player enhanced the heart rate variability during specific and non-specific chess tasks: chess problems, 15 + 10 games, and puzzle rush games. In addition, the sensorimotor rhythm power decreased during the chess problem and increased during the 15 + 10 game and puzzle rush. Also, chess performance and anxiety levels improved after the intervention. (4) Conclusions: Neurofeedback and biofeedback training combined with chess training could improve the performance of chess players.
... The electroencephalogram (EEG) patterns in anxiety have shown dysfunctional alpha, beta and theta brainwaves. Many studies have shown electrophysiological alterations in phobic anxiety such as increased alpha and theta brainwaves (Moradi, et al., 2011;Dong & Bao, 2005;Vanathy, Sharma & Kumar, 1998) and increased beta waves (Ribas, et al. 2018;Hammond, 2005). A review of EEG biofeedback by Moore (2000) among anxiety disorders implicated that enhancements in alpha-theta brainwaves can effectively reduce symptoms of anxiety disorder. ...
... EEG biofeedback (or neurofeedback) is a leading-edge technology which can be used as an adjunct treatment modality in altering the dysfunctional brain patterns associated with various neuropsychiatric conditions. This technique is said to be associated with fewer side effects or reactions and has been proven beneficial for being as non-invasive as medication, transcranial magnetic stimulation, or electroconvulsive therapy (Hammond, 2005). ...
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Magical belief and related behaviours are universal phenomena. However, it has been widely explored in relation with obsessive- compulsive disorder and psychosis. It is a much-researched topic of west but Asian data on the same is meagre. Aim- present study aims to explore magical thinking in Indian sample and its relation with OC features and perceived stress. The study also explores age and gender related difference in the sample. Methods- a sample of 246 participants (144 male and 102 female) from community was recruited. For this purpose, illusory belief scale was used to measure magical thinking, perceived stress scale was used to measure perceived stress and obsessive- compulsive inventory- revised was used to measure OC features in the sample. Results- group difference for females was found to be high on magical thinking measure whereas group difference for males was found to be high on OCI-r. Age-related variability was not observed in the study. Significant positive correlation was found between magical thinking, perceived stress, and OC features
... Biofeedback, as a general term, involves inhibiting excessive or reinforcing impaired physiological signals, which aim to teach the patient to regulate their emotions, thoughts, or behaviours in response to speci c stimuli, helping patients manage their symptoms (Ferreira et al., 2019;Schoenberg & David, 2014). In the case of psychiatric disorders such as anxiety, depression, and schizophrenia, biofeedback is applied with a speci c type of feedback from neural activity in target brain regions, i.e., neurofeedback (Schoenberg & David, 2014 Consistent patterns of OCD-related activity have been identi ed through quantitative EEG (qEEG) of patients OCD, with some showing an excess of alpha brain waves across most regions of the brain and other increased theta activity, primarily in frontal and posterior temporal areas (Hammond, 2005) .Clinical experiences from qEEG assessments of patients with OCD have demonstrated excess beta activity in the midline and cortical areas located approximately over the anterior cingulate, based on clinical experience (Hammond, 2005). Using fMRI as an alternative to EEG, the effectiveness of neurofeedback was demonstrated by showing that patients learned to modulate brain regions (the anterior insula and ...
... Biofeedback, as a general term, involves inhibiting excessive or reinforcing impaired physiological signals, which aim to teach the patient to regulate their emotions, thoughts, or behaviours in response to speci c stimuli, helping patients manage their symptoms (Ferreira et al., 2019;Schoenberg & David, 2014). In the case of psychiatric disorders such as anxiety, depression, and schizophrenia, biofeedback is applied with a speci c type of feedback from neural activity in target brain regions, i.e., neurofeedback (Schoenberg & David, 2014 Consistent patterns of OCD-related activity have been identi ed through quantitative EEG (qEEG) of patients OCD, with some showing an excess of alpha brain waves across most regions of the brain and other increased theta activity, primarily in frontal and posterior temporal areas (Hammond, 2005) .Clinical experiences from qEEG assessments of patients with OCD have demonstrated excess beta activity in the midline and cortical areas located approximately over the anterior cingulate, based on clinical experience (Hammond, 2005). Using fMRI as an alternative to EEG, the effectiveness of neurofeedback was demonstrated by showing that patients learned to modulate brain regions (the anterior insula and ...
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Introduction: Obsessive-compulsive disorder (OCD) is a psychiatric condition characterised by persistent, intrusive thoughts and ritualistic behaviours. This study assesses the impact of qEEG-assisted neurofeedback on two critical components of OCD: rumination, a maladaptive focus on problem causes and consequences, and cognitive avoidance (CA), the tendency to evade distressing thoughts aiming to evaluate neurofeedback’s effectiveness in reducing rumination and CA severity in patients with OCD. Methods: This controlled prospective clinical trial with parallel design included patients diagnosed with OCD, with Yale-Brown Obsessive Compulsive Scale (YB-OCS) scores ≥ 16. Subjects were alternately assigned to either the neurofeedback or control groups maintaining a 1:1 ratio. The neurofeedback group underwent 25 sessions over six weeks, with outcomes measured through the Rumination Response Scale (RRS) and the Cognitive Avoidance Questionnaire (CAQ) pre- and post-intervention. Results: Of the initial cohort, 30 participants finished the study. Significant reductions in Rumination and CA were observed in the neurofeedback group with multivariate ANCOVA showing a significant impact on CAQ and RRS scores (Lambda Wilks p = 0.001) and univariate ANCOVA indicating marked decreases in CA (p = 0.001, Eta² = 0.687) and Rumination (p = 0.001, Eta Squared = 0.636) compared to controls. Discussion: The findings substantiate qEEG-assisted neurofeedback’s role in significantly reducing rumination and cognitive avoidance in OCD, indicating neurofeedback’s potential to modulate brain regions implicated in OCD pathology, such as orbitofrontal cortex and anterior cingulate, thus enhancing self-regulation and reducing symptoms. Limitations: Limitations include no long-term follow-up, reliance on self-report measures, a small, single-centred sample, and convenience sampling, all of which affect the generalizability of the results. INTRODUCTION
... This controversial [41][42][43] form of therapy with questionable efficacy [44] has been explored as a treatment for some conditions, including attention deficit hyperactivity disorder (ADHD) [45,46], anxiety [47,48], depression [49,50], and epilepsy [51,52]. However, it's crucial to recognize that findings from neurofeedback therapy are specific to vulnerable patient groups with pre-existing conditions 8 and are influenced by the training and approach of the practitioners. ...
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Conventional electroencephalography (EEG) rarely appears in neuroethical discussions, despite its widespread use in scientific research. This oversight is largely due to its (perceived) harmlessness. There is limited empirical data regarding harm caused by EEG, with concerns mostly confined to its therapeutic applications. The conditions of EEG experiments, however, may require participants to remain still in an enclosed space for extended periods and maintain prolonged attention on monotonous tasks, sometimes while avoiding blinking. To date, there is no evidence of the impact of human electrophysiological research on psychological well-being. Could these demanding conditions impact participants’ well-being beyond the risk of physical harm? Our study represents the first dedicated investigation into this aspect. To assess changes in psychological well-being and contributing factors, we administered the Positive and Negative Affect Schedule (PANAS) to participants in three distinct electrophysiological experiments before the start of the preparation phase (pre-test) and again after the experiment concluded (post-test). Our findings indicate that participants experience significant changes in their affect from pre- to post-experiment, as measured by the PANAS. Specifically, there was a significant reduction in positive affect across the group, while changes in negative affect were not observed. Furthermore, our analysis revealed that the reduction in positive affect was significantly predicted by the duration of the experiment, identifying time as a crucial factor in the negative impact on participants' psychological well-being.
... In addition to pharmacological interventions, whose side effects however constitute the main reason for their discontinuation (Williams et al., 2007;Halperin et al., 2009), alternative approaches have also been used to address substance addiction (nicotine included), such as behavioral therapies and biofeedback and neurofeedback programs. BF and NF training have been shown to be effective in the management of anxiety disorders, depression and stress-related conditions (Hammond, 2005;Gruzelier et al., 2014;Tabachnick, 2015) and have been used since the 1970s, in the treatment of addictions (Lamontagne et al., 1977;DeGood and Valle, 1978). ...
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In recent years, the scientific community has begun tо explore the efficacy оf an integrated neurofeedback + biofeedback approach іn various conditions, both pathological and non-pathological. Although several studies have contributed valuable insights into its potential benefits, this review aims tо further investigate its effectiveness by synthesizing current findings and identifying areas for future research. Our goal іs tо provide a comprehensive overview that may highlight gaps іn the existing literature and propose directions for subsequent studies. The search for articles was conducted on the digital databases PubMed, Scopus, and Web of Science. Studies to have used the integrated neurofeedback + biofeedback approach published between 2014 and 2023 and reviews to have analyzed the efficacy of neurofeedback and biofeedback, separately, related to the same time interval and topics were selected. The search identified five studies compatible with the objectives of the review, related to several conditions: nicotine addiction, sports performance, Autism Spectrum Disorder (ASD), and Attention Deficit Hyperactivity Disorder (ADHD). The integrated neurofeedback + biofeedback approach has been shown to be effective in improving several aspects of these conditions, such as a reduction in the presence of psychiatric symptoms, anxiety, depression, and withdrawal symptoms and an increase in self-esteem in smokers; improvements in communication, imitation, social/cognitive awareness, and social behavior in ASD subjects; improvements in attention, alertness, and reaction time in sports champions; and improvements in attention and inhibitory control in ADHD subjects. Further research, characterized by greater methodological rigor, is therefore needed to determine the effectiveness of this method and the superiority, if any, of this type of training over the single administration of either. This review іs intended tо serve as a catalyst for future research, signaling promising directions for the advancement оf biofeedback and neurofeedback methodologies.
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Neurofeedback, a technique enabling individuals to modulate their brain activity in real-time, has garnered significant attention for its potential applications in clinical therapy, cognitive enhancement, and performance optimization. This review paper provides a comprehensive analysis of the current state of neurofeedback research, drawing insights from 65 seminal papers. We explore the historical background, methods, and techniques employed in neurofeedback studies, highlighting advancements and innovations in the field. Through a detailed examination of applications across various domains, including clinical settings and cognitive performance enhancement, we summarize key findings and efficacy of neurofeedback interventions. Furthermore, we discuss common limitations and challenges faced in neurofeedback research, along with future directions and potential advancements. By synthesizing insights from diverse studies, this paper offers valuable implications for the future of neurofeedback, emphasizing the importance of interdisciplinary collaboration and personalized approaches in harnessing its full potential.
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The field of EEG-Neurofeedback (EEG-NF) training has showcased significant promise in treating various mental disorders, while also emerging as a cognitive enhancer across diverse applications. The core principle of EEG-NF involves consciously guiding the brain in desired directions, necessitating active engagement in neurofeedback (NF) tasks over an extended period. Music listening tasks have proven to be effective stimuli for such training, influencing emotions, mood, and brainwave patterns. This has spurred the development of musical NF systems and training protocols. Despite these advancements, there exists a gap in systematic literature that comprehensively explores and discusses the various modalities of feedback mechanisms, its benefits, and the emerging applications. Addressing this gap, our review article presents a thorough literature survey encompassing studies on musical NF conducted over the past decade. This review highlights the several benefits and applications ranging from neurorehabilitation to therapeutic interventions, stress management, diagnostics of neurological disorders, and sports performance enhancement. While acknowledged for advantages and popularity of musical NF, there is an opportunity for growth in the literature in terms of the need for systematic randomized controlled trials to compare its effectiveness with other modalities across different tasks. Addressing this gap will involve developing standardized methodologies for studying protocols and optimizing parameters, presenting an exciting prospect for advancing the field.
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Biofeedback-assisted modulation of electrocortical activity has been established to have intrinsic clinical benefits and has been shown to improve cognitive performance in healthy humans. In order to further investigate the pedagogic relevance of electroencephalograph (EEG) biofeedback (neurofeedback) for enhancing normal function, a series of investigations assessed the training's impact on an ecologically valid real-life behavioural performance measure: music performance under stressful conditions in conservatoire students. In a pilot study, single-blind expert ratings documented improvements in musical performance in a student group that received training on attention and relaxation related neurofeedback protocols, and improvements were highly correlated with learning to progressively raise theta (5–8 Hz) over alpha (8–11 Hz) band amplitudes. These findings were replicated in a second experiment where an alpha/theta training group displayed significant performance enhancement not found with other neurofeedback training protocols or in alternative interventions, including the widely applied Alexander technique.
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The formal application of behavioral conditioning techniques for therapeutic purposes in epilepsy is of relatively recent origin. A comprehensive review of this area of investigation is currently being prepared for publication by Mostofsky and Balaschak at Boston University. One of the first definitive papers on this subject, however, appeared in the mid-50s when Efron reported the interruption and eventual elimination of generalized tonic-clonic seizures in one female patient with a 26-year history of the disorder. This patient experienced a well-developed aura which was inevitably followed by a grand mal seizure. When a specific sensory stimulus (strong, unpleasant odor) was applied early in the aura, Efron (1956) reported that further seizure development was consistently prevented. Application of the stimulus late in the aura resulted either in a partial seizure or a failure to abort. In further studies on this patient, Efron (1957) successfully paired the olfactory stimulus to a nonspecific visual stimulus consisting of a silver bracelet. Staring at this bracelet for several moments soon became effective in preventing seizure development, and eventually simply thinking about it was sufficient. This patient remained free of clinical seizures for 14 months. During the later months of this follow-up period the incidence of warning auras had sharply decreased, also, in spite of complete withdrawal of anticonvulsant medication.
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Obsessive compulsive disorder (OCD) has been the subject of a growing body of biologically oriented psychiatric research. There is mounting evidence for a neurobiological basis for OCD. Early studies of the conventional electroencephalogram (EEG) generally showed a higher prevalence of abnormal records in obsessional patients (Pacella et al. 1944; Rockwell 1847). Using quantitative EEG (QEEG) in obsessional patients, Flor-Henry et al. (1979) noted abnormalties in the left temporal region.